context bulk billing or patient claims
what the reader described was a
patient claim. Here the scenario is
simplified:
of whether it is 100%, 85% or 75%
of the schedule fee, you (the doctor)
can either:
1. Bulk-bill it, in which case the patient
and Medicare then pays the $30
directly to you.
obtain the $30 rebate from Medicare.
and you end up with the same amount
of $30 in your bank. However,
there are important advantages and
disadvantages for both you and your
patient that are worth considering.
that takes place between a doctor and
patient, in relation to the payment of
fees, is governed by the law of contract.
recent being Wong v Commonwealth
(2009). Wong involved a challenge to
the constitutional validity of both the
Medicare Scheme and the Professional
Services Review Scheme constituted
under the Health Insurance Act 1973.
The court decided, by a 6:1 majority,
that both were valid.
doctor and patient in the provision of
professional services. The High
Court held that the relationship
governed by contract and was a
private arrangement between the
two individuals.
a. Offer
b. Acceptance
c. Consideration
offer your services, the patient accepts
them and the consideration is your
fee. But the interesting question here
is: Where does the Medicare rebate fit
into the consideration element of the
transaction, and does that have any
impact on the contract itself?
examined the precise nature of the
contractual relationship between
doctors and their patients in the
claiming context. In this case the
court held that, under the patient-
claim options, the contractual
relationship between doctor and
patient is consistent with general
legal principals.
patient for the service fee, the doctor
obtains the payment from the patient
and it is irrelevant to the doctor that
either some or all of the payment
will be obtained by the patient from
Medicare. The doctor will therefore
have the usual debt recovery options
available for the recovery of any
unpaid amounts. This includes a civil
action against the patient for the
recovery of the full amount of the
fee or any unpaid balance.
claim is bulk billed what the doctor
effectively acquires to satisfy the
consideration element of the contract
is a right to a benefit that belongs to
the patient.
Court to be a gratuity rather than a
proprietary right Health Insurance
Commission v Peverill (1994) the usual
debt recovery avenues do not apply.
bill claim was unpaid, you cannot sue
the Commonwealth for its payment,
as there is no contractual relationship
between you (the doctor) and the
Commonwealth. You have no right or
remedy relating to the Medicare rebate
it comes out of consolidated revenue
and is a gratuity for the patient, not
the doctor.
DISADVANTAGES
to Claiming on Consumables, let's
now consider the advantages and
disadvantages of bulk billing versus
patient claims.
no apparent disadvantages.
directly into your bank account, in
most instances, and happy patients.
your service is determined by the
government and you have no legal
right to that benefit it is a gratuity
and you therefore cannot recoup the
Medicare rebate if something goes
wrong (though in practice this would
rarely occur, if at all).